Basic Information
| Provider Information | |||||||||
| NPI: | 1538423272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERICA | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 WILLIMANSETT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH HADLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010753000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305593930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 81 WILLIMANSETT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH HADLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010753000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135360912 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2012 | ||||||||
| LastUpdateDate: | 03/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 2425 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.